Great Challenges Final Exam

Epidemiology

The study of the distribution and causes of disease at the population level

Epidemiologts do…

Assess health of a population, determine causes of any health problems, and implement & evaluate solutions

John Snow

Demonstrated the spatial clustering of cholera deaths

Why did epidemiology expand beyond epidemics of infectious disease?

Infectious disease was no longer a leading cause of death

What do the results of epidemiologic studies do?

inform public health recommendations and clinical decision making

Endemic

persistent, usual, expected health-related state or event in a defined population over a given period of time

Epidemic

Health-related state or event in a defined population above the expected over a given period of time

Types of epidemic

outbreak- smaller, localized epidemic

pandemic- epidemic affecting a large number of people, many countries, continents, or regions

What are the standard dimensions used to track the occurrence of a disease?

Where (place), when (time), and who (person)

What is essential to epidemiology?

data, knowledge, and action

What is incidence rate?

number of new cases in a specific period of time/number of people in population at risk for the health outcome

What does descriptive epidemiology give?

information on the distribution and magnitude of the disease

What are two categories of epidemiology research?

descriptive- looking at the distribution of disease in terms of person, place, and time. hypothesis generating

analytic- evaluating risk factors for disease. hypothesis testing

Study designs

framework, or the set of methods and procedures used to collect and analyze data

Epidemiological hypothesis

a proposed explanation for a specific pattern or trend observed in health-related data, aiming to identify possible causal factors or relationships

Epidemiological studies

critical research strategies used to investigate the distribution and determinants of health-related states or events in specific populations, which aids in the understanding and control of diseases

Cross-sectional studies (descriptive)

researchers observe and collect data without intervening

data is collected from a sample at one specific moment in time

they measure the prevalence at that moment

Cohort studies (analytical)

start with an “at-risk” population - no one has the disease yet, but anyone can get it

compare incidence of the outcome of interest in the two exposure groups - does one group get more disease than the other?

Case-control studies (analytical)

an observational research method that compares two groups to identify past exposures that are associated with a current disease or outcome

Intervention study

interfering with the outcome or course, especially of a condition or process

preventive: education and skill-building workshop, social support/network building, screening, vaccines, environmental change

therapeutic: antibiotics, insulin

What is PERIE?

problem, etiology, recommendations, implementation, and evaluation. It is used to systematically identify, analyze, and address health issues in a community by first defining the problem, then finding its causes (etiology), developing solutions (recommendations), putting those solutions into action (implementation), and finally, assessing how well the interventions worked (evaluation). 

What is the epidemiologic triad?

agent <—> host <—> environment

direct- transmitted directly to person

indirect- transmitted via intermediate

vehicle-borne- transmission through contaminated objects

vector-borne- transmission by animal or arthropod host

contaminated objects, food, water, intermediate vector- mosquito

What are types of control used to prevent disease?

behavior change, vaccines, medication, environment, infection control, surveillance

Infectious disease

communicable disease

person to person

organism to person

cold, flu, poison ivy, lyme disease, strep, mono

What is the chain of infection?

infectious agents, reservoirs, portals of exit, modes of transmission, portals of entry, susceptible host

How can the chain of infection be interrupted?

kill pathogen with antibiotics, eliminate the reservoir, prevent transmission (wash hands, quarantine, condoms), increase resistance of host by immunization

What are the types of immunity?

active- infection or vaccination

passive- maternal antibodies or monoclonal antibodies

Master Settlement Agreement

requires tobacco industry to pay billions of dollars annually, forbids participating cigarette manufacturers from targeting youth, imposes restrictions on advertising and promotional activities, and bans or restricts transit advertising, outdoor advertising, product placement in media, branded merchandise, free product samples, and sponsorships

What are the lessons learned from tobacco preventions?

uses of data to understand the issue and who is most impacted is crucial for effective prevention efforts

knowledge is important, but is only step 1 - knowing better doesn’t always produce behavior change - need to address the context and underlying factors

community mobilization and policy development are essential

incentives like tax penalties disproportionately affect low-income populations

requirements require enforcement

Smart Growth

a planning and development approach that aims to create sustainable, healthy, and livable communities. It emphasizes thoughtful land use, transportation choices, and environmental stewardship to improve the quality of life for all residents—especially vulnerable populations such as older adults (U.S. Environmental Protection Agency [EPA], n.d.).

Mixed-use development

combining residential, commercial, and recreational spaces in one area.

Transit-oriented development

building communities around public transportation hubs.

Infill development

developing vacant or underused land within existing urban areas.

Complete streets

roadways designed for safe use by all—pedestrians, cyclists, transit riders, and drivers.

Green infrastructure

natural systems (like parks and rain gardens) that manage water and improve environmental quality

The built environment

includes buildings, streets, parks, plazas, and transportation systems

Social ecological model

individual factors, individual behaviors, public services and infrastructure, living and working conditions, social, economic, and political factors

Traffic calming

the combination of mainly physical measures that reduce the negative effects of motor vehicle use, alter driver behavior, and improve conditions for non-motorized street users

Advocacy

the process of education and persuading people to support an issue

Health Communication

the study and use of communication strategies to inform and influence individual and community decisions that enhances health

Misinformation

false information, or information taken out-of-context, that is presented as fact, but there may or may not be a specific intent to deceive

Disinformation

a type of misinformation that is intentionally false and intended to deceive or mislead

Ecosystem

a community of living organisms interacting with each other and their physical environment

What is One Health

a collaborative approach to achieve optimal health outcomes, recognizing the interconnection between people, animals, and the environment

What are the several fields that environmental health operates in intersection with?

history, sociology/psychology, science, medicine/epidemiology, policy, and economics

The Zadroga Act

2010 by Obama. allocated $4.2 billion to create the World Trade Center Health Program, which provides testing and treatment for people who worked in response and recovery operations from 9/11

What is mental health?

a state of well-being in which the individual realizes his or her abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community

Mental health conditions impact…

thinking, feeling, mood, and productivity

What are causes of mental health illness and conditions?

genetic factors- schizophrenia, bipolar disorder, autism, and ADHD

risk factors- individual, family, and community

Stigma

negative attitudes and inaccurate beliefs about people who have mental health conditions

stems from myths, inaccurate perceptions, and a lack of information

Prevention methods for mental health

teach coping and problem-solving skills

identify and support people at risk

promote connectedness

strengthen economic supports

strengthen acces and delivery of care

create protective environments

lessen harms and prevent future risks

What are health systems?

an organization of people, institutions, and resources that deliver health care services to meet the health needs of target populations (primary healthcare and public health)

healthcare models- universal and non-universal

Healthcare in the US

non-universal

decentralized- gov and other stakeholders make up the infrastructure

provided by the private sector (mostly)

paid for by a combination of public programs, private insurance, and out-of-pocket payments

What is primary care?

a main source for health care

designed to provide better access to healthcare, lower patient costs, and improve health outcomes

Federally qualified health centers

comprehensive services, primary care, visiting nurse services to homebound, outpatient diabetes self-management, medicare & medicaid insurances accepted, and sliding fee scale if household earns 200% or below poverty

Cost

dollar amount for a provider to deliver a health care service

Charges

the financial amount a health care provider asks for a service

often much higher than cost and reimbursement

only uninsured patients are billed charges

Reimbursement

amount a third-party payer (insurance) negotiates as payment to the provider

may drive charge inflation

Price

the amount a patient pays out of pocket for a service

hardest number to estimate, but this matters most to patients

Premium

the amount that an individual must pay to have insurance coverage

Types of private health insurance

employer

affordable care act marketplace

directly from a health insurance company

catastrophic healthcare insurance

Types of public health insurance

medicare

medicaid

children’s health insurance program

Parts of Medicare

Part A- hospital and outpatient services

Part B- medical service and inpatient

Part C- medicare advantage plan

Part D- Rx (prescriptions)

What make the costs so high in the US for healthcare?

aging population

defensive medicine

disconnects between the physician, patient, and insurance

administrative costs

What is the difference between PPO and HMO?

HMOs (Health Maintenance Organizations) are generally less expensive but less flexible, requiring a referral from a primary care doctor to see specialists within a limited network. In contrast, PPOs (Preferred Provider Organizations) are more expensive but offer greater flexibility by allowing you to see any provider, in or out of network, without a referral, although out-of-network care will cost more. 

What are Managed Care Organizations?

provide comprehensive care

receive a monthly, capped payment per member, and accept the risk of managing total costs

includes Medicare Advantage Plans and many state-funded Medicaid managed care plans

The Patient Protection and Affordable Care Act

2010

improving access to care

improving quality and lowering costs

new consumer protections

What are the potential impacts on public health and well-being if federal public health data offices close?

data gaps, delayed response, policy challenges, equity concerns, research limitations

What is prevalence?

measures the proportion of a population that has a specific disease or condition at a particular point in time or over a defined period, reflecting the total disease burden (new and existing cases)

What is a sentinel species?

an organism that serves as an early warning system for environmental health hazards

What is NIMBY?

in the built environment, NIMBY (Not In My Back Yard) describes residents opposing new developments (like housing, infrastructure, shelters) near their homes, fearing lower property values, increased traffic, crime, or change in neighborhood character, even while often supporting such projects generally, leading to significant planning hurdles and zoning battles